Provider Demographics
NPI:1619975521
Name:WILSON, PASCHAL P II (MD)
Entity Type:Individual
Prefix:DR
First Name:PASCHAL
Middle Name:P
Last Name:WILSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:961 S GLOSTER ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6343
Mailing Address - Country:US
Mailing Address - Phone:662-377-4550
Mailing Address - Fax:662-377-4425
Practice Address - Street 1:961 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6343
Practice Address - Country:US
Practice Address - Phone:662-377-4550
Practice Address - Fax:662-377-4425
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2017-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS15502207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSH64547Medicare UPIN
MSH64547Medicare UPIN